 |
| Lisa Romano |
Increasing a hospital’s physical capacity takes time and money. And even after making substantial investments, some hospitals still experience stagnant patient flow, which causes emergency department diversions, operating room holds, the inability to accommodate direct admissions, ED boarders and declines in patient satisfaction.
Successful capacity management requires a multifaceted approach that encompasses technology, data-driven project management, internal process redesign and organization-wide cultural change. Here, we’ll shine a spotlight on the benefits of specialized software and the valuable data it can provide.
Unite the Right Teams
The first step in improving capacity management is connecting transport and housekeeping with nursing and bed management. One organization that understands how these four departments contribute to patient flow is Saint Francis Medical Center, Peoria, Ill.
Saint Francis, the 710-bed flagship of the six-hospital Order of Saint Francis HealthCare System, struggled with ED overcrowding and other patient flow issues. In one year alone, the tertiary referral center and teaching hospital experienced 149 ED diversions. Internal investigation uncovered the primary culprits: bed cleaning, patient transport, and inadequate communication on bed and transport status.
Determined to address this problem, Saint Francis took three important steps. First, it consolidated bed management, patient placement (initial and patient transfers) and transportation to create a patient logistics department.
Second, the organization implemented an integrated software suite and an electronic bedboard to monitor bed status across 23 separate nursing units averaging 200 transfers and discharges each weekday. The technology tracks bed management and turnover, coordinates admissions scheduling prior to patient arrival and manages centralized patient transport services. It provides the patient logistics manager with the information needed to make real-time decisions regarding patient placement and movement. Because all process owners use the same information, the common data system creates accountability across the organization.
Third, the hospital installed a housekeeping coordinator within the patient logistics department to facilitate communication between patient logistics and environmental services.
In the year after implementation, Saint Francis’ capacity management strategies reduced ED diversions by approximately 60 percent. Patient care and satisfaction improved, plus the incremental increase in admissions brought in $287,000 in net revenue. The capacity management strategy also reduced staffing costs. Daily bed management meetings between nursing and admissions--which translated into more than 2,700 person hours or 1.3 FTEs over the course of a year--were eliminated. The handful of telephone calls among admissions, nursing, PACU and ED to coordinate each admission or transfer were no longer needed. By streamlining processes and reducing phone traffic, staff was reduced by one clerk and one nurse, representing annual savings in salaries and benefits of more than $150,000.
Consolidate and Routinize Transport
As Saint Francis Medical Center learned, a central transport team is essential. In most organizations, the transport request process is fragmented and differs based upon destination. The request typically is made by telephone, and locating a transporter often involves physically looking for one or calling on the intercom. Too often unit-based employees are pulled away from patient care duties to transport patients when this function could be performed more quickly and cost effectively by a dedicated transport team.
In addition to the transport team, Saint Francis developed a standardized process that included protocols for requesting transport and response-time expectations. Transport tracking software allows for automatic dispatch by phone or computer, and each stage of the transport--request, in progress and complete--is time-stamped. This data is used to monitor staff productivity and process efficiency.
Using the new processes, Saint Francis’ response times and use of transporters improved. The hospital was able to reduce its transporter staff from 22 to 18 and its dispatchers from 2.4 to 1.4 FTEs--a 20 percent reduction in staff-related expenses--while increasing the numbers of jobs assigned to the transport team.
Streamline Housekeeping Dispatch
In most hospitals, unit-based staff who have multiple and often competing responsibilities are responsible for cleaning discharge and transfer rooms. Like the transport function, these tasks should be assigned to a dedicated team within housekeeping so that multiple rooms can be cleaned at the same time.
At Saint Francis, the bed tracking technology can generate a bed-cleaning request, communicate that cleaning is in process and indicate when the cleaning is complete. For example, when a patient is discharged in the ADT system or a transporter escorts a patient out, an interface to the bed tracking technology automatically pages the housekeeper for that room. All points in the patient flow process are time-stamped so that housekeeping staff can be held accountable for response times. Reports generated by the software can be used for two purposes: setting goals with the cleaning team and parallel-processing when there are multiple beds to clean on one unit.
The importance of including housekeeping and transport with nursing and bed control in the patient placement structure cannot be overstated. While these groups may seem to have different and sometimes competing goals, a successful capacity management strategy demands that they share one objective: to maintain patient flow. Each member of these four departments must understand how his or her specific responsibilities impact patient flow. Setting patient flow targets specific to each role fosters compliance with established policies and procedures.
Data Drives Improvement
Information technology can forge the connection between cleaning and transport and the patient placement structure. It can provide real-time updates and enable organizations to set targets and monitor performance. It also permits instant communication and transparency so managers can see potential bottlenecks and make appropriate, timely modifications.
Hospitals that have maximized existing capacity began with an understanding of how people, processes and tools drive capacity constraints and opportunities. They recognize that success demands superior technology and coordinating many interdependent processes. Finally, they appreciate the importance of organization-wide culture change for sustainable, long-term success. The only way to change culture is to hardwire behavior, and the only way to do that is with hard data from the patient placement process.
Lisa Romano is director of Avanti Patient Flow Services, a division of TeleTracking Technologies, Inc., Pittsburgh.
GIVE US YOUR COMMENTS!
HHNMostWired welcomes your comment on this article. E-mail your comments to mostwired@healthforum.com, fax them to Most Wired Magazine Editor at (312) 422-4500, or mail them to Editor, Most Wired Magazine, Health Forum, One North Franklin, Chicago, IL 60606.
If you would like a FREE Subscription to Most Wired OnLine, please click here to register.
This article first appeared on July 11, 2007 in HHN's Magazine online site.
To respond to this article, please click here.
